We may think that trauma leaves irreversible scars, reshaping our brain and emotional regulation permanently. The science, however, shows the opposite, says psychologist George Bonnano. Our biology is much more resilient than we give it credit for.
Bonanno dismantles common myths surrounding trauma and PTSD, and shares a practical mindset shift to navigate difficult experiences.
Timestamps
0:00 Rethinking trauma
01:07 The human capacity for resilience
04:33 Potentially traumatic vs. just really hard
09:28 Four pathways after adversity
15:45 How our brains encode trauma and shape our memories
26:20 The resilience paradox
31:27 The flexibility sequence
37:00 Why flexibility matters for healing
50:41 The history of PTSD
1:00:54 The psychology of grief
1:03:31 How the brain processes loss
Transcript
The below is a true verbatim transcript taken directly from the video. It captures the conversation exactly as it happened.
Rethinking trauma
The big question, really, when I think about trauma is how do most people respond to the things that we think of as traumas? I tend to use the word potential trauma or potentially traumatic event. That’s because events are not traumatic, they’re potentially traumatic, but how do most people respond? We know that some people get PTSD, but what do most people, how do most people react? And when we can see that, then why is it that people react certain ways? This is the question really that’s occupied my career.
My name is George Bonanno. I’m a professor of clinical psychology at Columbia University. My most recent book is titled “The End of Trauma: How the New Science of Resilience is Changing How We Think About PTSD.” I’m known for identifying and documenting human resilience in the face of, basically, the worst things that happen to people
The human capacity for resilience
It’s difficult for me to identify one myth that I’d like to debunk because I’d like to debunk a bunch of them. There are at least three very much interrelated misconceptions about trauma right now. One is that anything very difficult and unpleasant, hard, can cause trauma or is a trauma. Another is that anything that we consider a trauma has lasting emotional damage. And the third, which is very pernicious, is that there are hidden traumas that we’re carrying around PTSD like traumas in us somewhere, and they’re hidden from us, yet they are continuing to harm us and to cause difficulties in our life.
I have to confess, even saying that makes me feel funny because as a scientist, when you say, “we carrying around with us hidden traumas,” I want to say, “where are they?” Because we don’t have mechanisms for those things in our bodies. We have for a long time; we tend to essentialize trauma. We think that trauma exists in nature, PTSD exists in nature. We didn’t think it up. We discovered it. That’s the way it’s viewed.
And by the same token, resilience exists in nature and we discover it. So these things just are, and people therefore are either going to be traumatized or they’re going to be resilient just because of who they are. None of that is actually true or accurate, but it leads to an absence of inquiry into what’s really going on. Why is it that some people develop PTSD? Why is it other people don’t? That’s really the question we have to get at.
I began studying these phenomena around 1991, and at that time, resilience was known. It was largely seen in children faced with really caustic environments, children going up with chronic abuse and poverty or people in Civil War. Things were really draining, demanding caustic environments.
When it came to potentially traumatic events, the assumption was that that’s just too much. That’s overwhelming because they’re so acute, so intense, so focused that very few people can deal with that. The same was actually thought about loss, about grief as well. So when in our research we began to identify and show that, look, people are actually resilient to these events, a lot of people are. Most people are. It was met initially with not really much of a rebuttal, more of indifference.
I was young, I was a new investigator, I was using some different methods that had been used, and the assumption was, I must be doing something wrong. Either that or this can’t be true. And initially a lot of people on the more clinical end of things would tell me, that’s just plain wrong. I don’t know what you’re doing. You’re probably a good researcher, but that’s just not true.
And that lack of the reason, it wasn’t so much pushback as much as simply just ignoring the idea. And when I first began to publish these papers, I published these papers with my colleagues. My colleagues didn’t want me to use the word resilience because that seemed too provocative to use that word.
Get expert classes, premium print issues and exclusive events.
Potentially traumatic vs. just really hard
I left home when I was 17, and I left a fairly, for lack of a better word, unsavory home. It was a violent home. And I left, I sat out on my own at 17 with no money, nobody in my corner. Around the age of 19, I had made my way to Arizona and I had a part-time job. At the time, I didn’t seem to need a lot of money, and I hitchhiked to Central Arizona where there’s a lot of Indian reservations, Native American lands. And I reached the Salt River Canyon at dusk. I decided to walk in and camp. I saw that there was a river going through the Salt River. There was a sign that basically said, if I can translate this, this is Apache Reservation Land. If you go in this canyon, you’re on your own, basically. No one’s gonna come get you. There aren’t many of us here. Something like that. It was a long time ago, 50 years ago. So I’m paraphrasing.
There were a number of warning signs of flash floods that I just simply did not pick up on those. I was young, I didn’t know that much about the desert. I hiked into the canyon aways until the trail disappeared, climbed up to a ledge about 10, 15 feet above the water, pitched my tent and went to sleep. So in the middle of the night, it began to rain, and I heard the water running by.
I thought this may be damaging my tent, so I pulled up the rain flight, stuck up my flashlight, and the river had risen to where my tent was and was rushing by, it’d risen about 10, 15 feet. I panicked. Got up quickly, it was raining now, pulled my tent out as fast as I could, gathered it up, looked around me. And there’s this now river that’s much wider than it was before, running by me quite fast. Lapping at the very spot where I was.
I was panicking, I was focusing my thoughts as best I could. I climbed up about another 15 feet to a very tiny ledge and got myself there. Eventually, my dog made his way up, I was very happy about that. I didn’t know the river would take my ledge with me as it withered away to canyon. And I sat perched on that ledge for a long time, wondering what was going to happen to me.
I was running in my mind all the realization that where I was sleeping is now underwater. Had I not woken when I did, I would’ve been swept away essentially in a big nylon bag that was my tent, and I would’ve surely drowned the most horrific death. It wasn’t until years later when I began to study people coping with trauma and loss that I began to see how resilient people were.
And at first I thought, why have I not gone through anything like this? All these people go through these horrific events, why have I not gone through one of these events? And then I remembered that event and I remembered all these other events, many other events that I’d gone through that would qualify as traumas or potential traumas that were just simply poignant, disturbing at the time, difficult but not traumas.
I defined trauma in a fairly simple way. I defined trauma a lot, like the way it was first defined in 1980 when PTSD became a diagnosis. It’s an event out of the range of normal human experience. So it’s an unusual event that is violent and or life-threatening. And the most typical prototypical examples are something that in an event in which you could die, be seriously injured or endure sexual violation. That’s kind of the broader nexus. And there are a lot of exceptions and the kind of events that fit that rubric.
Some events can also be potentially traumatic if we imagine them as violent or life-threatening in a way that even if they’re happening to somebody else, we can imagine them happening in such a way that might allow us to feel traumatized by that. But for the most part, there are a lot of really unpleasant events that are just not traumatic events or potential traumatic events. And there’s very good reason for that because they inculcate different reactions.
So say in a devastating financial crisis. A devastating relationship. Something that happens that just changes your life in a very negative way. Those are very unpleasant events. They can cause psychological harm, but they’re not traumatic events or not potentially traumatic events. That’s because the reactions that they create look different, feel different, and have a different constellation. Our brains do different things. At least if we want to understand these events, we need to be really clear about how these different events play out, different types of events.
Four pathways after adversity
Resilience is an outcome. We tend to assume that people are resilient or not resilient, but that just doesn’t hold up when we try to investigate that, when we try to understand it. We can only talk about resilience in relation to something. A person is resilient to this thing that happened. So in this case, we can look at potentially traumatic events, we can look at broader categories of events too, things that depress people or make people anxious.
We can be resilient to any of these horrific events or difficult events, taxing events, unpleasant events. And we are resilient if when one of these events happens, for the most part, we continue on a stable trajectory of healthy functioning. So we’re able to endure one of these events and continue to function relatively normally afterwards. That doesn’t mean we didn’t get upset.
Most people do get pretty upset when bad things happen. That’s natural. In fact, our stress response only works when we feel stress. We have to trigger that response in order to cope with it. Most people do get pretty upset, but resilience then is being able to continue functioning in a way that we would that is basically healthy. And in the simplest terms, that means having the capacity to concentrate, to focus, and do what you need to do in life. One’s job or whatever that might be, and to be close and intimate with other people.
It turns out when we study people over time, the majority of people show that resilient pattern. We call it the resilience trajectory. The majority of people will endure a highly aversive, a very extremely unpleasant event, a potentially traumatic event, and still be able to continue functioning relatively normally, relatively in a healthy way as they had before. The range varies a little bit on average, it’s around two-thirds of the people exposed to these events will show that pattern.
Most people are resilient, but that still leaves many people who will suffer in some lasting way from exposure to one of these aversive events. We’ve been able to identify several different patterns by tracking people over time.
One response is to become very upset and struggle in a much more demanding and difficult way for a longer period of time. And then gradually return to a normative level. Gradually return to the functioning that seems to that person healthy. And it could take a year for that to happen, sometimes even longer. We call that a recovery pattern. And we do see this, we see quite a few people showing this pattern.
So in other words, they are in a way more disequilibreated, more disturbed, more distressed by the event over time than someone who was showing that resilient pattern, but they are going also to recover and get back to their normal range.
Another pattern we see are some people who are struggling more than they expected to and then they’re not getting better, they’re getting worse. They gradually suffer more symptoms, things begin to steamroll, and then gradually they get into high levels of symptoms and they’re really struggling and they need professional help. That could happen for many different reasons. It could be that whatever event they went through has some lingering consequence, maybe they were injured and they suffer a lot of pain. Maybe the event result in a lot of upheaval in their life. And so that upheaval is now continuing make difficulties for them.
It may be they’re upset and disappointed that they’re not getting better and they’re getting depressed about not getting better. There are many different reasons for that. That’s a delayed pattern, but it begins with struggling and then getting gradually worse.
Then another pattern we see, the third pattern among those people who aren’t resilient is what we call basically chronic distress or chronic symptomatology. That’s a person who is really seriously traumatized by the event, really deeply upset if it’s not a potential traumatic event. They continue to struggle for a long time. It’s really relentless and it’s long lasting harm. And that’s unfortunate, very unfortunate, but it’s real. It happens in less than 10% usually, but it does happen quite a bit.
I coined this phrase, “the resilience blind spot” to capture a phenomenon that I’ve seen now for many years. I saw this in the research I did after the 9/11 attacks in New York City. I was in New York City at the time. I’ve saw it again recently with the COVID-19 pandemic very clearly. What happens with the resilience blind spot is it’s most apparent with a large scale disaster because many people are affected and there is a kind of a shared anxiety, distress, concern, upset among many people.
And there’s a little bit of social contagion there. We tend to see other people being upset and then we feel upset. We worry more. These events that 9/11, COVID-19 pandemic, the super storm Sandy that was in New York City a number of years ago, the tsunami in Japan. Lots of these events, they happen, they’re going to happen again. They’re very, very disturbing.
And when people are upset, it’s just a way our minds work. It’s very hard for us to believe that it won’t last, that it’s a short-lived phenomenon. This goes all the way back to my friend and colleague Dan Gilbert at Harvard had talked about this in terms of affective forecasting. When we’re feeling emotion, it’s hard to imagine that it’s ephemeral. It’s hard to imagine we won’t feel this way forever or for a long time.
So when we are upset because of a disaster, a mass event that’s fed by all the attention it gets, it’s fed by the media, it’s fed by conversations we have with other people, it’s fed by what we know is happening. It’s so upsetting that we live blinders like a horse wears blinders or a blind spot like we have a blind spot in our eye for the idea that this will pass, that we’ll be okay.
How our brains encode trauma and shape our memories
What is happening in our brains when we’re exposed to a potentially traumatic event? To be perfectly honest, we don’t know the story in full detail, because we can’t. We can’t put people in experiments and traumatize them. Most of what we know is extending what we do know very well about how we respond to extreme stress.
And what we know from this research is that we have a remarkable stress response. It’s magnificent, actually, in my mind. It’s magnificent. It’s multifaceted. It’s multi-phasic. It can last for a very short time or a long time, and it can manage different levels and different kinds of challenges. What happens initially, which we used to know is the fight or flight response, that phrase was coined in the early 20th century by the great physiologist Walter Cannon.
He didn’t have the tools we have now, and so we’ve taken that idea a lot further. Essentially what happens is when our sensory organs send signals to the brain, typically the midbrain, they get shuffled around a little bit. If they match some presets or some things we’ve learned, they get shuffled to another structure, the amygdala, and that may shuffle it over to hypothalamus.
All of these structures are filtering almost like little computers, binary computers, is this something threatening? Is this dangerous? It doesn’t have to be fully verified. It all it needs to do is match the kind of the basic minimum level of a possible strap, and that will send a cascade of biological responses throughout our body. Our brain orchestrates how our body functions.
It does this normally by keeping it in a nice delicate balance of things ramping up and ramping down so that everything stays nice and balanced, and functional in our bodies. When that threat alarm goes off, when those brain structures say there’s something really dangerous going on right now, it shifts that balance. The things that we need most get ramped up. So blood gets pumped up. We pump more blood, it goes to the extremities. We produce more glucose. That goes to the extremities too. We’re gonna need that. We breathe more heavily, our eyes, our pupils dilate, so we take in more information. And some of the things that are not necessary gets shut down. We don’t need some of these other bodily functions, take them offline temporarily.
At the same time, there’s a shift in what our brains are doing from reflective, thoughtful processing, like what I’m doing right now, to much more immediate, almost autopilot, habitual and automatic processing designed to deal with what the brain thinks is happening. That also has consequences for how we experience and remember these events because it focuses only on the bits and pieces of information that are most relevant for our survival.
It doesn’t care about the broader context, the broader narrative thread. It’s just the things we need to know. How fast is this moving? How sharp is this thing? How bad could this be if I fall? All these bits and pieces of information.
If the threat continues and the alarm continues to go off, that sends more signals and the structure of the hypothalamus will then send signals through our blood, neurochemical messengers through our blood that will go down to the adrenal glands and release cortisol.
Cortisol has been released earlier, but it does something different now. It travels through the blood and when it reaches the brain, it bonds with some of those same brain structures only now it results in genetic change, an epigenetic change in those structures so they can do what they need to do, even in a bigger way, even more powerfully, and they really ramp up this stress response. Things are not going well. So we need a bigger response.
At the same time, there’s a blockage of our long-term memory, which is really intriguing. We can’t voluntarily recall things in the past very well ‘cause we don’t need that information at this point. It’s just distracting. We can remember details, but we can’t remember narrative long-term memories because we don’t need them. So that’s happening, and that can last for quite a long time up to a couple hours.
And this cortisol, it’s wonderfully balanced, it’s kind of got a braking system built into it. So some cells react very strongly to cortisol and they have kind of a what’s called a high affinity for cortisol. So they respond right away very powerfully to the presence of cortisol in the brain. Other cells have a low affinity of cortisol. So there’s a kind of a building up of cortisol and then it gets shut down and gradually declines.
That whole arc can last a good couple hours. We’re in essentially an alternative state of consciousness during that time because our brains are focused in a different way. Initially, we’ve gone from this habitual automatic kind of processing, eventually to a more reflective, goal-driven processing after time when that becomes necessary. And that sweep is very interesting.
I get very excited about this because I think it’s a marvelous system and we all have this as part of our basically inherited biological capacity. The brain activity we see in relation to extreme levels of stress has some clues about why people also develop PTSD and why many people don’t. Many people don’t develop PTSD or lasting harm because these brain processes are very, very effective.
But for some people they may be less effective and that in part may be because of a lack of cortisol, and there’s some evidence to suggest that some people have lower resting cortisol. There are complicated reasons why that may have come about, there’s still a lot of work trying to figure that out. Some people also have a more sensitive cortisol break, which shuts it down more quickly, and that that seems to have an epigenetic component meaning some earlier life experiences may have primed the system to be say, not reactive enough or over reactive in terms of shutting it down. All of that is hard to demonstrate in research but that seems to be an emerging idea.
The way our brain works when we’re under extreme stress results in very fragmented memories of these events. The bits and pieces. I think that’s highly adaptive because it gives us kind of generic information we can use. And next time something really difficult happens if it would happen again.
I remember after the tsunami in Tokyo, I was shown a videotape of an airport flooding and I’d never seen an airport flooding. And what I remember from that as it just a couple key incidents, the water arriving, how fast it came, and what happened when it met with the planes, some things floated up, other things didn’t. None of that was information that I had before. The rest of that video I don’t remember, but I remember those bits and pieces.
So that’s the experience we have of most potential traumatic events, bits and pieces of decontextualized information. Now, whenever we remember something, we re-remember it in a very organic way. In my field, we call that consolidating and reconsolidating. When we remember something, it’s a biological event, so we’re consolidating all that brain activity in some way that we can remember it when we go back to it.
And then when we go back to a memory, we reactivate those same biological systems and then after we’re done thinking about them they go back in the memory. They get reconsolidate, only the difference is now we have other experiences, the experiences we had when we were remembering. So the memories gradually change. I think a lot of what we think of as memories of trauma are these bits and pieces of information that we later put together into a story.
It’s a very interesting phenomenon. That’s something that we’re still trying to understand, but it can go for the worse or for the better. It goes for the worse, if we then begin to tell ourselves how horrible something was and we begin to string pieces together in a quasi invented narrative. It can help us in the future if we gradually put some distance between ourselves in that memory and we gradually remember these events in a more benign way or in a way as if we were watching them.
In fact, we did some research on people who had gone through the 9/11 attacks. People who were actually in the towers or near the towers on September 11th. All those people were in life-threatening danger. What we found was the people who either recovered or showed that resilient pattern had their memory changed over time. Their memory of those events became more benign.
The people who remained traumatized had pretty much, they had some variation in their memory, but it continued to be a very disturbing memory. There’s something in the way we think about these events over time that we don’t fully understand yet, but it’s a little bit removed from what actually happened.
So what about the diagnosis of PTSD? Is it useful to be diagnosed with PTSD if somebody is generally suffering from PTSD and I think in terms of my research, we see that there are certainly people generally suffering from PTSD. The range varies, but I think having a diagnosis of anything that we’re really struggling with is useful, is helpful. It’s both comforting because we now know what it is we’re struggling with and it means that somebody else knows what it is we’re struggling with. If somebody diagnoses us and it means there are treatments we can learn about that are specifically for that thing we’re struggling with.
The downside of that is that the PTSD diagnosis is porous and people can be diagnosed with PTSD when they actually don’t have PTSD. That does happen, unfortunately, far too often.
The resilience paradox
When we began to become confident that we really had identified something real, this resilience trajectory I’ve talked about, we’ve identified it in many studies at this point, it’s been identified convincingly in the majority and over 100 research studies by other people than myself, lots of other people. So it’s very much a real thing. The big question then is why are most people resilient and why are some people not resilient?
That turned out to be a harder question to answer than I thought because when we measure the things that correlate with resilience, the things that co-occur with resilience, we find loss of different factors. The kind of a myth in the general public, we see it in the media, we see it in even in some professional literature, is that there are a few magic traits. The three traits of highly resilient people or the five traits of highly resilient people.
It turns out there are many factors that have been associated with resilience, but they all have what we call small effects. They don’t explain very much. They only explain a little bit of who will be resilient. In other words, if somebody says has positive thinking or they’re good at problem solving or they’re good at distracting themselves or whatever it is that they do that is something that helps them to be resilient. It turns out that that only predicts a little bit of whether or not they will actually be resilient when something happens.
I call that the resilience paradox. We can identify these things, but, paradoxically, they don’t actually predict who will be resilient the next time something happens. The reason for that it turns out is because situations vary a great deal, and there are cost and benefits to everything. These different factors that we think make us resilient, these different behaviors, even the go-to things that we think we use when we are trying to cope with adversity, they only work sometimes. They work sometimes in some situations and they don’t work very well in other times. Even the things that we think are our best shot don’t always work.
What that means is every time something happens, all of us, we have to work out what’s the best solution, what’s the best strategy for this particular moment right now? This particular situation I’m in. I call that process of doing that adaptive flexibility, I’ve also called it regulatory flexibility.
Adaptive flexibility is basically a set of skills that most people have actually, which is a good thing. Most people have those skills, they’re also highly learnable. But even if we have those skills, we have to use the skills we have and that’s work. In order to do that work, we have to be motivated, we have to believe that we’ll be able to do it otherwise we won’t even try.
That belief, that idea that I’ll get through this eventually. I’m not happy this happened, this really sucks, this is painful, it’s ruining my life, but I’ll get through this eventually. That’s the belief that we need in order to do that work. We need to somehow think we’ll get through it.
We call this the flexibility mindset. There are three core beliefs that seem to comprise the flexibility mindset. They’re related and they feed off each other.
One of them is optimism. That’s essentially a belief or conviction that it’s going to be okay. The future will be okay, this isn’t good now, but it will be okay in the future. You can see this in sports, you can see it in many other domains of life. There are some athletes who have all the skills in the world, but if they don’t have the motivation, if they don’t have the sense of purpose, they’re not going to perform well. You see this over and over in sports, we need to always have that motivation, that belief that I’ll get through this. I can do it.
So another one of those beliefs is confidence of coping, sometimes called coping self-efficacy. This is essentially a belief that I have some ability to cope and most people do. Most people have at least some coping that they can do some behavior, some coping mechanisms that they can use. It’s a sense of reminding ourselves, I can cope.
The third component of this that appears to be part of the mindset is what we call challenge orientation. Sometimes called challenge appraisal. That’s when we think of threatening events in terms of the challenge at hand, what we need to do to get through it. When we’re first confronted with a threat, we naturally assess the threat because we need to know how bad something is. But at some point we have to shift from thinking about the threat to thinking about what we need to do to get past it. If we stay too focused on the threat, we’re paralyzed by that. The challenge appraisal is a sense of, all right, what happened? What’s the challenge here? What do I need to do?
The flexibility sequence
Our research program gradually began to point to three key components, three steps of what we now call the flexibility sequence. I pulled these together for the first time in my recent book, “The End of Trauma” and lay them out in some detail. The first step and all three of these come from our research.
The first step we call contact sensitivity. And this is where we stop and we, when something is disturbing us, we’re upset. We stop and we reflect and we think, what is the problem? What’s happening right now? What’s the problem and what do I need to do? This is really about the moment. One of the difficulties we experience sometimes when we’re really upset by something is we take a very broad perspective. This thing happened, it’s ruining my life. It’s horrible. That’s too big of a problem to undo all at once.
We need to take it in pieces. What’s the problem at hand? What’s the problem in this moment that’s really bothering me? It may be that I’m feeling anxious. It may be that when I go to this one place, I get really anxious because this is the place where this thing happened. It may be any number of of reactions we have and we have to take these one at a time.
When we think about, okay, I need to sleep. The problem is I’m not sleeping well and that’s making me unhappy during the day and it’s making me have trouble concentrating and then I’m worried about my job, whatever that may be. What do I need to do? I need to focus on solving that problem. How do I sleep better? Or I need to focus on feeling less anxious in the moment.
Once we’ve done that, we have a clear problem we can solve. We move to the second step of the sequence, which we call repertoire. Here we decide on a strategy we’ll use. We call it repertoire though, because all of us have a repertoire of personal strategies, the things that we know how to do, the things we’ve used in the past, and we choose from that repertoire. It’s kind of like a toolbox.
We open up that toolbox and we say, alright, I need to sleep better or I need to feel a little less anxious now, or I need to find a way not to feel threatened when I’m in this situation. We look in that toolbox and we decide which of these tools is going to be best to use right now?
We try something out that takes us to the third step, which we call feedback. This is quite simple in a way. We just simply monitor what we just did and ask ourselves, is it working? As simple as that may sound, this is really a key step because a lot of people give up here. If they try something, it doesn’t work, they think, I can’t deal with this, I just can’t cope with this. I tried doing this thing where I distract myself, so I won’t think about it. I tried getting wrapped up in my job, which really helps me a lot and I still kept thinking about it. I can’t cope with this, and that’s actually a very dangerous misconception, because what we need to do in this situation, as it laid out in the flexibility sequence is we go back to the repertoire step and we try something else.
We try another strategy. We might have to continue trying strategies several times before something actually works. Or if we’ve tried many strategies, it may be that we have to go all the way back to the beginning and think about the problem in slightly different terms. Maybe I’m focusing too broadly, I’m focusing on the wrong problem. What’s the problem that I can solve right now?
There’s a lesson in all of this in these different pieces of the flexibility sequence because not only does it give us tools for dealing with these challenges, these averse events we experience, it also essentially is teaching us about our own mastery. We can actually do something about these events. We can actually work these things out ourselves over time. It does teach us really that we don’t need to simply let things happen to us.
There’s a phrase, “Time heals all ills” and time does heal things, but time is in no rush. Time takes a long time. We can actually get in there and work to get ourselves through these events in a way that we’re making the decisions. We’re trying things out.
The good way to think about this is even when we try something and it doesn’t work, we’ve tried it, it’s been our choice to try it. We know now this isn’t working, let me see what else I have. And over time we also begin to learn more about our tools. We learn more about how we perceive things, we learn more about the tools we have, and we can actually think, okay, this tool worked pretty well in this situation and now I know I have this tool. And I saw somebody else, I heard about somebody else doing this other thing. Maybe I’ll try that in the future. I’ll put that in my toolbox.
There are a lot of ways that we can grow as people and become more efficacious and more independent in a way with these kinds of tools. I think there’s a general idea that it’s pretty easy to latch onto that somebody might think I’ve been traumatized and it’s really ruining my life and I just have to limit my life now. There’s nothing I can do about it. It’s just happened to me. There’s a lot of helplessness built into that idea.
The flexibility notion, the sense that we can actually get in and change the way we’re experiencing the world, the way things are happening to us. The challenges we face—I think gives us a lot more efficacy, a lot more mastery, a lot more sense of agency in how we deal with these events.
Why flexibility matters for healing
I coined the term the fallacy of uniform efficacy, because I see this in the way people talk, and I see this actually in my own research discipline. This idea that there’s some behaviors, some strategies that people can use that are just golden. They always work. They are the perfect strategies, and then there are others that are just not healthy. They’re maladaptive. Don’t do these things, these things are unhealthy.
In fact that doesn’t hold up to the research at all. The fallacy of uniform efficacy is that any strategy is always good or always bad. We find that there are strategies that people like to use. There are strategies that are healthy and good strategies to use, but in certain situations, even the most unhealthy strategy can actually be adaptive.
I call this coping ugly. It’s the idea that say something like doing some impulsive thing is not really healthy. You don’t need to be self-destructive here. If you do something that once or twice in certain situations, it’s actually can be just what you need to do. John Lennon wrote a song, “Whatever gets you through the night”. That’s exactly what this kind of idea embodies.
By the same token, the things that we think are always healthy, we should just do these things. They’re not always efficacious. They don’t always work. Great examples are something like mindfulness. Mindfulness is good stuff, there’s no doubt about that. But mindfulness isn’t always going to solve a problem unless you are maybe one of the 18 people in the world who can meditate all day long. Most of us can’t do that. Most of us use mindfulness in a kind of a daily way or however anybody uses it. That’s going to help a lot, but it’s not gonna solve every problem.
Social support is another one. Turning to other people for comfort and advice that helps in many situations, but it doesn’t always help. It doesn’t always give us what we need for a particular problem.
The way I actually got into a lot of this flexibility research was by studying emotional suppression. I was doing research on suppression at the time. There were a lot of people beginning to study this behavior, but it had developed this reputation as being uniformly bad, uniformly maladaptive. There are plenty of anecdotal examples that show that suppression can be very adaptive in some situations.
For example, in our 9/11 research parents who are with young children told us in interviews that they had to really suppress all the emotions they were experiencing at the moment because they didn’t wanna frighten their children. When you’re in the midst of a tremendously challenging situation like a war, for example, there are times when we have to just simply bottle up whatever we’re feeling because we need to remain focused on what we’re doing. We need to concentrate.
There’s some research even about suppressing positive emotions. There have been some studies where the people winning awards, people winning sporting events if the the winners show too much positive emotion, other people actually don’t like them because they feel like they’re being inconsiderate of the losers; the people who didn’t win. In many social situations, many dangerous situations where we need to suppress the emotions we feel. Of course, in other situations that’s not adaptive because in other situations we need that information. What are our emotions telling us? Like every strategy we use, it depends on the situation, it depends on the challenge we’re facing in that moment.
Often this simply comes down to trial and error, and trying something and asking ourselves, is this working? If it’s working great, let’s keep doing it. If it’s not working, we need to try something else. Adaptive flexibility and the flexibility mindset, the flexibility sequence, these concepts can also be useful if we’re thinking about how to cope with something that happened some time ago as say a a potentially traumatic event that did cause us lasting harm and is still causing us lasting harm.
In this case, we have to focus on using it the way we use it for current events. If we think about a traumatic event that really did upend our life that we’re still struggling with, we tend to think of that event and we will tend to think of that event in a broad, generic way. I was traumatized by this event. It’s changed my life. I can’t go out anymore. I don’t do the things I used to do. My relationships are not so good anymore because of this because I’m kind of in this broken state. That’s a problem that can’t be solved in one go. It’s too big of a problem.
But what we can do, just like anything that’s happening currently in our life, is we go through the steps of the sequence, the flexibility sequence, and think about it in terms of what’s the problem in the moment, what’s happening right now?
What is a piece of this problem that’s bothering us and that we can address? An example comes to mind of someone I knew long time ago who was traumatized to such a point that that person never went out anymore. They were worried that if they went out, they would have a flashback and be overwhelmed and be somewhere out in public in this sort of flashback panic attack state. So that became the problem. How can I go out into the world despite the fact that I am feeling quite vulnerable, quite fragile at the moment?
The solution was to first identify that problem, then to think about strategies that might help with that particular problem. Which led to a gradual kind of realization. That person could tell friends had never told a lot of friends that he had PTSD, he could tell friends he had PTSD and then those friends could be kind of safe houses for him. So that was a step. Try that out. How’s that working? Then again, so we go through the trial and error process. Let’s try telling some friends, I have PTSD and let’s try then going out and knowing that we can call them if I’m feeling upset, that seemed to work really well.
I went out the other day, I tried this, I felt a little uneasy. I called my friend. I went over there. I didn’t have a flashback, I didn’t have a panic attack, but I was able to feel like I could go to safety if I needed it. Okay, that worked. Let’s expand it a little bit. And that person gradually developed a way to get back out in the world. That gave him more confidence in what he could do out in the world that allowed him to deal with some other pieces of the problem.
So he broke it down that way and took it one at a time, tried to find the solutions to the trial and error approach, paying attention to the feedback. Did it work? If it worked, great. If it didn’t work, try something else. This gradually allowed him to give himself more latitude in his life. He had tools to address the pieces of the problem.
We can use self-talk as both as a tool and a reminder for how to use the flexibility components in our lives. So self-talk is something we naturally do. We condense what’s going on in our mind, and our minds running all the time, and we condense what’s going on in our mind into a few sentences. We might say them aloud or we might say them to ourselves.
Unfortunately, a lot of self-talk we use is negative. We might say to your ourselves, “ah, dummy” or something along those lines. “Why did you do that?” But it can also be used positively. And people do naturally use positive self-talk. The classic one word, “yes”. You see this in sporting events, you see it in other contexts, people taking an exam or some context, and that has been harnessed in many different disciplines. It’s been harnessed in education. It’s been harnessed to a great deal in sports and in clinical context as well.
It’s a way of condensing what we’re thinking to phrases that we can use then to remind ourselves and guide us through some behavior. For the flexibility mindset, we might actually make a little chart of these kinds of phrases. In my recent book, “The End of Trauma”, I have a little chart of these phrases in the back, but there’s simple things like for the flexibility mindset, we can tell ourselves things like, it’s gonna be okay; I have some tools to work with this. Or for challenge appraisals, so what’s going to be okay would be being optimistic about it. It’ll be okay. The future will be okay.
Confidence in coping. That would be something along the lines of: I have some tools. I know how to cope. And challenge appraisal would be something like, okay, this sucks. I didn’t want this to happen. What do I need to do to get through this?
For the flexibility sequence, these are also quite simple for assessing the context. We can say to ourselves, what’s happening now? What do I need to do? And that actually is quite powerful. I’ve found I’ve used this in my own life when I’m struggling with something and it’s confusing. I’m feeling upset and then sort of take a second back and say, what’s happening? What do I need to do here? It really helps us focus in on a core piece of the problem. What is it that I need to do right now?
Once we do that then the repertoire stage, we can just say, so what tools do I have in my toolbox? What kind of things can I use here to cope with this? These are simple statements, but they have a way of focusing our mind. When we’re talking about the flexibility sequence, this is a kind of a dialogue. A lot of self-talk are just simply statements like, I’ll get through this, this’ll be okay. But when we talk about the flexibility sequence, we’re actually asking ourselves a question. We’re having a dialogue with ourselves. It’s almost like having ourselves in the room next to us, asking us these questions. It’s simple and easy and very effective.
There’s a phrase that is often used when my work is talked about, summarized as, “you are stronger than you think”. I’m a little leery of that phrase because it’s presumptive. I don’t know what anybody thinks, but it is fair to say, I think there’s a cultural trend toward thinking we’re all pretty fragile right now. I think that’s more and more been the case. I don’t know exactly why it is. It has something to do with the internet has got us focused on how dangerous, how harmful the world is right now by all the things that we perceive that we’re fed because it gets our attention.
But there’s also a lot of industry that’s sprung up around this idea, the industry that feeds off the idea that we are broken and fragile. And I think that’s not a good trend. As I’ve said, the flexibility ideas are kind of a counter to that because it puts us back in the driver’s seat. But I think that it’s good to remind ourselves of how strong we actually are.
It can sometimes seem like a tough sell. This idea that you are, you can actually get through something. That you’re stronger than you might think you are at the moment. It’s really important to cut yourself a little slack and to allow yourself to take on that belief for a little while at least to let yourself dig in and try to move forward with your life. You can remind yourself, both that you are strong. You can also remind yourself of all the times you’ve been strong in the past, all the things you’ve gotten through.
A little exercise that I like to do is to think back in my own life in the past when something had really upset me as something had led me to feel like my life was really going to take a dark turn or some bad thing had happened and then I got through it. And I would love if someone from the future could have come back to me then and said, “Hey, you know, you got through this,” right when I was struggling with it. “You know, you’re struggling now, “but you actually-I know I’m from the future. “You got through this,” and it’s hard.
Something that we don’t tend to believe at the time, we tend to feel like this struggle is means I am weak. There’s a related literature from the wonderful work by Carol Dweck on growth mindset. It’s the idea that if we think that something is fixed, a quality in us is fixed, then we tend to give up. If it looks like we’re failing, that means that we must not be good. If it’s fixed and I’m failing, it means I must be bad at this.
But like many things in life, flexibility is about trying, it’s about using the skills and doing the work to get through something.
Resilience is not fixed. Resilience is an outcome, and the idea with the flexibility is to get in there and dig in and work to get through something. And when we do that, more often than not, we do get through it. If we think, “I’m doing poorly, that means I’m broken”. We are not going to get anywhere with that attitude. The best we can do is to just give ourselves the chance to believe we’ll get through a situation, and most of the time we will.
The history of PTSD
We often think about whether life is more traumatic now than in the past because the idea of trauma is so ubiquitous now. I think it would be a hard argument to win to think that life is more traumatic now than in the past or more difficult. One of the things that’s happening now, is that there’s so much of a focus on trauma.
And I think the primary reason is there are a couple different factors that come together. One is that our brains are very much wired, if I can use that phrase. They’re not really wired, but they’re very much preset to pick up danger and immediate threat because for that makes perfect sense from an evolutionary perspective. We can die very quickly if we’re not careful. So our brains are set to detect those kind of dangers in our environment.
Now we have the internet, and the internet has become gone from this kind of interesting idea in the beginning to unite the world and communication. It’s gone from that to an enormous moneymaking machine. The money on the internet is about capturing your attention. The more it can capture people’s attention, the more advertising revenues can be generated. That’s just how it works now. And everybody knows this is not a mystery.
In that context, it’s easy to capture people’s attention with threatening things, with information about dangers. Look at what happened. Look at what’s happening here. Look at these people, how upset they are. Look at how unhinged, how damaged this person is. All of these things capture our attention big time. It’s hard not to look at those things because our brains want to know. We want to know where the dangers are.
There’s more, and more, and more of that than there’s ever been before. On TikTok, which everybody knows is a social media platform, there’s a phenomenon called trauma dumping. People are posting their traumatic experiences on TikTok and then there are sites that are gathering those into one place and those are enormously profitable. So this kind of thing, doom scrolling, all of these things, these words that we have now are because we can’t look away.
In that context, we gradually come to believe whether we realize it or not, that we’re now seeing the world as an increasingly dangerous place. A place that can harm us. And we begin to see our own failings as a result of all of this harm.
A very interesting question is, what trauma was like in the past? If we think about the fact that we do seem to focus on trauma much more now, were people not traumatized in the past as much?
It’s very curious because if we go back in time, we see hardly any references at all to trauma, to the symptoms of trauma that anything like PTSD. Of course the concept of PTSD we wouldn’t see, but there’s really no mention really of people being traumatized, having nightmares and being harmed by an event, a potential trauma. We don’t see that really at all in historical literature.
We do see plenty of evidence for grief. We can go all the way back to Homer, The Iliad and The Odyssey. There’s plenty of mention of soldiers openly grieving. So people knew about that. People honored that. All those gory battle scenes. There’s no mention of soldiers having PTSD like symptoms in any of the accounts. Maybe a little bit of a hint here and there, as we get into the 16th century, 17th century,. There are actually some kind of quasi accounts, but we don’t really get into any full blown mention of something like psychological trauma, until the 19th century.
Until near the end of the 19th century, and it was actually a German physician who mentioned it for the first time right at the end of the 19th century called the traumatic neurosis. Then we come into the 20th century and we have World War I and we have newspapers, we have much more cultural transmission, and we have the idea of shell shock that caught on in World War I. World War I was a pretty horrific war. Modern weaponry had advanced to the point where it, in a sense outpaced war tactics leading to a lot of carnage.
Not that there wasn’t carnage in the past, but in around the time of World War I, we began to think about this idea of something called shell shock. It wasn’t universally accepted. In fact, many people were considered cowards if they claimed to have shell shock.
There was a famous phrase in England called, “shot at dawn”, which meant that if a soldier had said they didn’t, they weren’t going to fight or they couldn’t go back to the front because they had shell shock. They were shot for cowardness. Shot at dawn. That really happened quite frequently.
Then there was a little bit of a lull. It was well known. It’s documented in literature and things in the 20th century that some soldiers seemed to be broken by the war. Then World War II happens and we had a lot of the same situation where soldiers were being psychologically disturbed. It still wasn’t clear though. People were not clear what to call that.
That didn’t really change until 1980. This is in the aftermath of the Vietnam War. Up until that point, the early mental health manuals, if they talked about anything like trauma, they didn’t really use the word trauma. And they talked about it more in terms of there’s something wrong with that person. There’s a weakness in that person. There some deficit in them that allowed them to be traumatized.
That changed in 1980 with the advent of PTSD. A lot of it had to do with the Vietnam War where it was a pretty horrific war, wars are generally horrific. The Vietnam War was US soldiers fighting in the jungle. So it was guerilla warfare. The soldiers were not really prepared for that. When soldiers came home from that war, many soldiers developed drug addiction as a way to cope with that war. When they came home, they were not often treated very well because the war was very unpopular, even though soldiers were drafted. Soldiers who had been drafted basically had no choice but to go to the war or face criminal charges or leave the country.
Those soldiers were often castigated for having been soldiers and many of them self-medicated. They had no other way to take care of themselves, and that led a lot of treatment providers to finally, in 1980 to designate PTSD as an officially recognized disorder so they could actually treat those soldiers.
When we think about this history, the absence of trauma in the historical record, it really begs the question, maybe we’re just making it up now. I don’t think that’s true, especially I’ve worked with people who have PTSD as a therapist and it’s very clear to me some people really are harmed by trauma. So what’s going on there? In the past, weren’t people traumatized?
A really nice piece of information to fit into that are the diaries of Samuel Pepys. Samuel Pepys was an aristocrat in the 17th century, he was a contemporary of Isaac Newton. He knew the king. I think that was Charles the 16th in England. And Pepys was in the inner circle of the king. When the London fire happened in 1666, it was a horrific fire. Huge portion of London burned in that fire.
The king asked Samuel Pepys to go around and assess the damage and report back to him, so Pepys saw the extent of it. He felt the heat. He felt like his feet were burning through his shoes, he saw horrific flames, and smoke, and carnage. He saw the whole thing. It was very disturbing to him and it effected him. Now, we wouldn’t have really know about Pepys if it wasn’t for the fact that he kept a diary for about 10 years.
He wrote everything down. He wrote unabashedly, everything down and largely because he wrote it in a kind of a code he invented, not a tremendously difficult code, but it was a code. He didn’t intend anybody to read it in his lifetime. So he felt free to speak completely uninhibited, uncensored. When he died, he left all his books, including those diaries to the University of Cambridge.
And it was about a hundred years before anybody took a good look at them and realized there was something there and decoded them, they were absolutely fascinating. They’re like looking into the brain of somebody in the 17th century and listening to what they say and how they experience the world. And Pepys talked about that fire.
He talked about his reactions to that fire and how confused he was. Months later, he was having nightmares. And about six months later, he wrote in his diary something to the effect that he could not understand why he couldn’t sleep because of fear of the fire. Fear of fire, and why he was having nightmares about fire.
He was basically having PTSD symptoms. What’s interesting about these Pepys diaries is he was confused by that. He didn’t understand why he was having those symptoms. Now, this is one very nice piece of evidence, but it’s only one piece of evidence: it suggests to us that he was having genuine trauma symptoms, but they were so unspoken about, unknown, that he didn’t understand what it was and why it was having them.
I think that’s probably a better way that we can think about this, that people did have trauma symptoms, but they were just kind of this thing that nobody talked about and nobody really acknowledged.
The psychology of grief
When I finished my PhD, I was looking to change directions a bit. I had been studying experimental clinical psychology and I wanted to get a little bit broader, more in the realm of what people do in their daily lives. I was offered a position in San Francisco at the University of California in San Francisco studying bereavement.
I knew almost nothing about bereavement at the time, and, frankly, I wasn’t interested. So I thought about this a bit, looked into the literature, and when I looked into the literature, I was kind of surprised. I was actually amazed. The literature was so antiquated. It looked like a literature from the 19th century. The assumption was everybody grieves, and it’s a horrible thing for everybody. Everybody needs clinical help — just about everybody.
So I thought this was very intriguing. When I looked at the methods being used, I realized these were also not very modern methods. So I took this position in San Francisco and I had a lot of resources at my disposal to study how people cope with the death of a spouse. What we did was not so much revolutionary as just common sense in a sense.
I used the research methods I’ve learned instead of getting a clinical sample, people looking for treatment, we got a broad range of people, literally anybody who lost a spouse within a few months of that time, and we studied them using the techniques, as it mentioned. I learned like coding their facial expressions, running people through experiments with psychophysiology attached, transcribing what they said and doing text analysis following people over time.
And almost immediately we saw that most people were coping really well. The majority of people were resilient to loss. I wasn’t actually expecting that, but that was kind of an interesting surprise. We then did another study and found the same thing. And that led to, basically, my entire research career, we broadened into studying trauma, and we’ve been using a lot of those same techniques for the next 30 years.
And we found that most people are resilient. Sometimes I have called the death of a loved one, a potentially traumatic event, simply because that term allows for a kind of a broader inclusiveness, but grief and trauma are really very different. They are different kinds of events and they result in very different reactions, very different brain activities, very different longer term processes on our part.
How the brain processes loss
A potentially traumatic event is an intense life-threatening event that turns on all kinds of emergency reactions, and that in a way forces us to rethink what life is a little bit. The death of a loved one does something very different. The death of a loved one tells our brain that what we think is the world is like in terms of other people, isn’t correct anymore.
It also introduces a big existential threat because most of the time, as the Buddhists say, “Life is impermanent.” We don’t live — we live only a certain period of time, and that’s a fact that we just don’t keep in our awareness very much. When a loved one dies, it’s staring us in the face. That person that I knew doesn’t exist anymore.
These bereavement events are very challenging. Most people cope well with them over time like anything else, but they still require us to get through them. One of the things that happens when we lose a loved one is we become very sad. And sadness is highly functional. All emotions are functional, we’ve evolved emotions for a reason, as they do something.
And what sadness does is it turns our attention inward. In contrast to trauma where there’s a uptick in arousal, we’re on edge. When we lose a loved one, our system slows down. We actually have a decrease in heart rate. The world slows down and we withdraw from the world some deeper into our own heads, for lack of a better word.
The reason that that’s adaptive is because when we’re attached to someone, anyone, and when I say attached, I mean it in the most common sense way that people have become a part of who we are. They’re in our minds. We think of those people when they’re not there, and they become a little bit of a part of our identity.
The people that we’re deeply attached to are often not in our life at the moment. That’s just the way life works. They’re off somewhere else during the day or whatever, but they’re in our minds. When that person dies, our brain is completely confused by that. Our brain doesn’t know what to do with that information because our brain is not a being, it’s an organ inside our head. We are the being. So the brain needs to recalibrate. It needs to come up with a way of thinking of the world where that person is no longer living and no longer living in the fresh, but they can still be in our mind.
In the old Freudian concept, I think Freud used the word decathecting. I never fully understood what that meant, but it means to something along the lines of breaking the bond with that person. So you’re no longer grieving, but I don’t think that’s actually what we do.
We can still be attached to somebody in our minds. We can still have tremendous love and affection for somebody and wish we could be with them, but we have to realize that they’re dead. It’s very difficult; and we’re gradually coming to terms with it.
There’s a very prevalent idea that is dominated the way a lot of people thought about grief is the so-called five stages: denial, anger, bargaining, depression, and acceptance. This idea was that we go through these five stages in sequence until we are then done with the grieving process. Unfortunately, there’s really no evidence. There never has been that this is how we grieve. We don’t see this when we look at what people are doing, when we look at resilient people, for example, that most bereaved people show this resilient trajectory.
They’re already basically functioning and moving on very early on. It seems highly unlikely that they did a kind of a five stages on steroids in order to get through. They go through a different process. And we see a much more idiosyncratic process than most people go through. It’s very personal, it’s not so neat and tidy.
In fact, the five stages were originally formulated for in the Kubler-Ross’s work on how people face their own death. There’s no research on that either, for obvious reasons. It’d be pretty hard to research people facing their own death. But she had proposed that as what based on her clinical work with people facing their own death, she had proposed those stages.
Then another group of investigators foisted those stages onto bereavement. So she actually didn’t propose those as the way people grieve. But somehow that became the way that most people now think of loss, it’s a very dangerous idea. It may be helpful to some people because we do like having a roadmap. We do like having something predictable.
But the problem is that a lot of people will be very upset that they don’t seem to be going through those stages. Or other people in their life will tell them “you’re not doing this right” because you shouldn’t be already feeling good right now because you haven’t gone through this stage yet. You haven’t gone through this depression stage or this denial stage. So you’re going to be in trouble in the future.
It can be really problematic. Actually, a sad but wonderful example of this comes from the spinal cord injury literature. I did some research on spinal cord injury and looking at that literature because as usual, we found that most people are resilient. And people who suffer spinal cord injuries, permanent loss of bodily functioning, also show the same resilient pattern even when they’re in the hospital.
Soon after the event, they’ll show that same healthy psychological functioning across time. In trying to understand all that, I looked to the spinal cord injury literature. And I found a book from the 1960s when that literature was just beginning to take off. And one of the chapters in that book argue that if a spinal cord injury patient isn’t depressed, their doctor should make them depressed so that they can go through the stages toward recovery. That’s a bizarre idea.
A common thing that bereaved people report is that they have these quasi hallucinations. They think they see somebody in public, a person passes by that looks like them, and you swear that there they are right there. What are they doing here? They’re dead. Or people report being home, and then they might hear keys jingling in the hallway if they live in an apartment building and thinking their partners coming home only to realize that that’s somebody else’s keys.
Those kind of quasi hallucinations because the brain is still operating on the assumption that they’re still alive. The brain is a prediction machine. The brain is constantly trying to predict what life is. What will happen next? And it needs to go through this process where we gradually recalibrate, reconfigure the world without that person living, and it takes time.
So we go deep into ourselves. We’re trying to think through who was that person? What can I carry forward in a way? This is actually one of the interesting things that we do, we condense what we knew of the person in their life into a form that we can take with us almost as if we had something tangible that this is the person. This is their life. This is the relationship I had with them.
We’re very generous when we do that. We tend to idealize a little bit here. Not a tremendous amount, but a little bit. We round off the rough spots. We don’t necessarily forget some of the negative things that a person did, and sometimes there are a lot of negative things we have to contend with, but we tend to round off or we give them a little slack.
We do this in mourning ceremonies as well. Mourning ceremonies are interestingly oriented around the very psychological processes that we actually have to go through. In mourning ceremonies, people tell stories about the person that’s deceased. They tell stories about the person that they knew. And those stories serve the exact same function, they’re pleasant.
They round off the rough spots and they condense it down into these memories, and we can then carry that forward, this idealized version. The interesting thing about sadness, it’s so ubiquitous when people are grieving and it’s functional, it does what it needs to do. It helps us when we turn inward. But when we turn inward, we’re vulnerable because we’re not paying attention to the world around us.
Now, this is fine if we’re in our own home, of course the danger is that we’ll stay in our internal world to such an extent that we begin to ruminate and that actually can lead to a worse outcome. But it’s also dangerous in the modern world simply because we’re not paying attention. It might be driving a car and not paying attention or in the subway and not paying attention walking down the street, any number of things. Making a meal and getting lost in sadness and forgetting about it. Leaving a burner on the stove. All those things are quite dangerous.
In our evolutionary past, it was much more dangerous because there were predators and there were lots of other dangers that people had to contend with. So we’ve seemed to have evolved a kind of an oscillatory way of grieving. We go inward, we do this sad, deep kind of internal reflection and then we come back out. We attend to the world around us again. We attend to the people around us and then we might go back in. We go in and out of these phases of focusing on the world around us and turning deeply inward. And that seems to be a much more adaptive way.
We’ve seen this in our own research when we studied laughter and smiling. It turns out that most bereaved people will show genuine laughter and smiling even when they’re struggling, even when they were crying moments ago. We can do this in our research by coding the muscles in the face. There’s certain muscle reactions that we see in the face that are indicative of genuine positive emotion.
We see them when people smile genuinely and when they laugh genuinely. And what we found in interviews we’ve done, is that people might be talking about the loss and crying and their face is just contorted in pain. And then seconds later they’re thinking of a funny story and they’re actually laughing as they’re telling the story, and they are still tears running down their face. They might be in that state for three or four minutes and then they’ll go back into this deep internal state.
This is a kind of a turning in and turning out, but the laughter part’s also because they’re connecting socially with the people that are around. That’s very important part of life is a very important part of bereavement because we need other people to help us through loss.
When we connect back with them and we laugh, that laughter’s contagious. It’s a way of almost giving people something. You’re taking care of me, but I’m going to smile and laugh with you for a little bit and that makes other people feel good. And then we’ll go back in. We’ve seen this many times in the research and it really seems to be again, part of the marvelous set of tools we have to cope with life.
We sometimes see anger during bereavement. Anger is, like a lot of negative emotions, it’s very useful in specific situations and specific contexts. When anger happens during bereavement, it’s usually when we feel like this pain we’re experiencing is in some way somebody’s fault. That could be the medical establishment. It could be ourselves. We can be angry at ourselves for we perceive not doing something we could have done. People are sometimes angry with the person that died for not doing the thing that would’ve helped them survive. That’s useful to a point, again, as it fits the situation. If there’s a time when we need this to simply sort of get that off our chest, those are thoughts we’re having, we want to express those thoughts, that’s when the anger can be useful.
It becomes maladaptive if we do it a lot or all the time. Just like anything else in the broader idea about flexibility. Anything that we do too often is maladaptive because we’re not paying attention to the situation. So some anger is useful, a lot of anger is not useful. There are some people who endure the death of a loved one who are not able to get over that loss.
They continue to suffer. They continue to feel intense pain for years even, and that’s horribly painful. It’s horribly unpleasant. It’s tragic in many ways. The person that they’ve lost is no longer with us and they can’t move on in their life. There are lots of different ideas about what can be done to help people in that situation. There are some tools and techniques people have talked about.
One is actually having conversations with the deceased person and talking through what it is they think happened and what it is they think their life is like, etcetera, and might make them feel connected. It might also help allow them to get feelings off their chest that maybe anger at that person or guilt at something they did or something they didn’t do.
There is also, it is very important to get out into the world, even if we don’t feel like getting out in the world. Sometimes just exercising is very important because it helps us function better, helps us feel more alive. We sometimes need to review what that person meant in our life. If we were highly dependent on them for a certain part of our life that’s very difficult.
But then we need to find a way to develop that own part of our life in their absence. Another big part of it, which is actually a component of a lot of treatments, successful treatments for grief is to think about how we’re conceptualizing the loss. How are we explaining it? And often, I hate to use this word, but often people have what are typically called dysfunctional beliefs.
They’re often erroneous beliefs that somehow we caused the death or somehow we didn’t do enough, or somehow the person died angry at us or whatever we may be telling ourselves. There are a number of existing treatments that actually have proven quite efficacious. Many of them use cognitive behavioral components, which focus on this core part, how we understand the loss and how we understand the loss actually drives how we react to it.
So getting at that piece of it, another related part is actually involves exposure. Which means talking about the loss from beginning to end. The leading up to it, what happened, and how you reacted. Because, interestingly, when we are really distressed by an event, when we’re really disturbed by an event, we tend not to think of it as a whole piece. We tend to think of it in little bits and pieces, images that come to mind. Unpleasant images, something somebody said, something we said, a visual image, a sound. Those happen and we right away want to push them away because they’re so painful and so unpleasant, that we don’t pursue the entire story. One of the things that treatments do now is they ask people to tell the whole story from beginning to end.
When you’re telling that story, a person who’s lost a loved one, who’s struggling from beginning to end to another person, especially a person that we assume is an expert, we’re kind of laying it out there. This is what actually happened which helps us, interestingly, understand how we are thinking about that event and how we’re placing ourselves in that story often in ways that are really not founded.
Things are usually not a person’s fault. Now, one of the things that is important is this idea of continuing bonds because we do have a continuing bond with someone, and one of the terms of when people can’t get over lost, it’s often used as yearning. There’s this sense of I want this person back, I want them to be alive and that is painful. That’s what we experience a lot in the beginning of a loss.
But we have to move beyond that because they’re not coming back. We can continue to have that bond, but it transforms into a bond with the person who is no longer alive. I’m personally very comfortable with having bonds with people that are dead in my mind. I don’t know what happens when people die. I don’t think anybody does. It’d be nice if we knew, but we don’t. We really can’t say.
We’re free to do it as we wish with the idea that the person may be somewhere we’re talking to them or we don’t know. One of the things we can do is actually write letters to people, have conversations with them. I had a very complicated relationship with my father. When he died, I continued to have conversations with him in my mind, actually a lot more than I did in the 10 years before he died because I wasn’t around him. I used those conversations to actually talk about the past with him. It was really helpful to talk about the things that bothered me. To talk about the things that I may have been misunderstanding or understanding. And to also ask for him to do the things as a father that I would’ve liked to ask him if he were still alive.
For example, when I had my own children, I had a lot of questions about what being a father is like. And I asked my father, as if he were alive, which allows me to continue that relationship fully aware that the person no longer lives in the world. Now I did this in my — I live in a New York building. I did it in the elevator, purposefully, because the door is really slow. So when the elevator stopped, I knew the door was going to open and I could stop talking to the air.
It’s a little odd to be doing these things and many people might feel uncomfortable with it, but it is one of the really nice ways we can have a sense of a person. We can also think about what the person’s life meant to us. What would they have wanted? What would’ve made them happy if they continued to live? These are actually very nice ways to be with a person and to use their memories to hold onto their memories. We can also think about what they would’ve liked us to be doing.
I remember there was a quote, I think Paul McCartney said this. He had been in a very healthy marriage with his wife Linda McCartney. And when she died, he moved on in his life. And I think he said she wouldn’t have wanted me to suffer and pine away for this lost marriage, this lost relationship. She would’ve wanted me to move on, and that’s what I’m going to do.
I think we can think about the person that died in that way. They’re still with us in a way in spirit, and we can think about what they would’ve wanted, what they would’ve wanted us to do, etcetera. It’s a mysterious thing we’re given. This period of time we have to live and then it’s over, and we can do with it what we will or not.
